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NEWS / Lancet editorial: For universal health coverage, tomorrow is today
« Last post by agate on September 22, 2017, 04:57:05 pm »
Editorial in The Lancet, September 23, 2017:

For universal health coverage, tomorrow is today

In a Comment published alongside the Lancet Series America: Equity and Inequality in Health in April, 2017, Senator Bernie Sanders (I-VT) wrote: “Today, we must do everything we can to prevent the repeal of the [Affordable Care Act (ACA)] and oppose attempts by the Trump administration to undermine it by failing to enforce the law or promulgating regulations that would sabotage it. Tomorrow, we must work to join the rest of the industrialised world and guarantee health care to all citizens through a Medicare-for-all single-payer system.”

The push to usher in “tomorrow” has increased momentum. On Sept 13, 2017, Sanders, along with 15 other Democratic senators, unveiled the Medicare-for-all Act. The plan proposes a complete overhaul of the US health-care system by establishing the Universal Medicare Program (UMP), a single-payer system that would end the ACA marketplaces and prohibit private health insurers. The core benefits covered by the UMP draw on the essential health benefits laid out by the ACA, including inpatient and outpatient hospital care and emergency services, primary and preventive care, prescription drugs and devices, and comprehensive reproductive and maternity care. Further, the UMP would eliminate all so-called cost sharing for consumers, such as copays and deductibles. The Medicare-for-all model would be all inclusive, covering US citizens and immigrants, as well as potentially undocumented immigrants, and, unlike the current Medicare system from which it draws its name, it would cover individuals of all ages.

For its proponents, the single-payer plan outlined by Sanders' bill is the gold standard ideal for achieving universal health coverage (UHC) in the USA. Indeed, the advantages of single-payer systems in other contexts are plain—all citizens are covered, care is affordable and accessible, and administrative waste is dramatically less. But the case for a single-payer system in the USA is a far more complex, and costly, proposition. Health care comprises about 17·8% of the GDP (US$3·2 trillion) and for the federal government to solely assume that financial burden would require substantial tax increases across the economic strata. Furthermore, health care is also the leading driver of job creation. Convincing Americans to forego that growth as well as to embrace a fledgling single-payer option in lieu of employer-provided health plans would be a huge challenge.

With varying levels of support among Democrats, however, and none from Republicans who control all three branches of government, there is wide acknowledgement that Sanders' bill, as it is formulated, cannot pass. Which has left many pundits asking whether the USA is simply not ready for a single-payer plan. Despite the dilemmas accompanying Sanders' bill, recent public polls indicate that there is moderate and growing support for a single-payer plan (33%) and surprisingly strong agreement that the federal government's responsibility is to ensure that all Americans have health coverage (60%).

Whether or not Americans favour single-payer as the route, UHC should firmly stay the goal. According to 2016 US Census Bureau data, the uninsured rate fell to 8·8%—the closest the USA has come to UHC. Barometry of public opinion aside, the ACA remains the single most critical instrument for improving the rates of coverage.

Yet even after the spectacular failures of the American Health Care Act and the Better Care Reconciliation Act earlier in 2017, Republicans are insistent on a last-ditch effort to pass legislation repealing the ACA through the process of reconciliation—which would only require a 51-vote majority—before the Sept 30 deadline.

Following the release of the Medicare-for-all bill, the Graham-Cassidy-Heller-Johnson Amendment, has taken on new urgency with the Trump administration and Senate Majority Leader Mitch McConnell (R-KY) behind it. It would shift federal funding for the ACA to block grants for the states to administer, eliminate subsidies for private insurance, and end Medicaid expansion—a move that would severely undermine the coverage gains, increased access to care, and improved health outcomes achieved, especially for low-income Americans.

Although the two major plans under consideration could not be further apart, it is important to recognise that many other health-care reform plans are currently being pitched and refined, variations on the theme that might include, for example, revisiting a public option alongside private insurers. The renewed discussion is a strong testament to the important contributions of progressive voices such as Sanders for continuing to champion a way to cover all Americans. But for now, tomorrow must also be today as legislators must work to continue to defend the ACA while helping the USA find its path to UHC.

NEWS / Graham-Cassidy bill might repeal ACA on a tight timetable
« Last post by agate on September 21, 2017, 03:48:49 pm »
The Republicans just might ram their new "repeal/replace Obamacare" bill--the Graham-Cassidy bill--through the Senate unless some obstacles are put in their way.

This article discusses the bill (from MedPage Today, September 21, 2017):
TREATMENTS / (Abst.) 2-year results from phase 2 extension study of oral amiselimod in RRMS
« Last post by agate on September 20, 2017, 02:55:23 pm »
From Multiple Sclerosis Journal, September 15, 2017:

Two-year results from a phase 2 extension study of oral amiselimod in relapsing multiple sclerosis

Ludwig Kappos, Douglas L Arnold, Amit Bar-Or, ...


Amiselimod, an oral selective sphingosine-1-phosphate 1 receptor modulator, suppressed disease activity dose-dependently without clinically relevant bradyarrhythmia in a 24-week phase 2, placebo-controlled study in relapsing-remitting multiple sclerosis.


To assess safety and efficacy of amiselimod over 96 weeks.


After completing the core study, patients on amiselimod continued at the same dose, whereas those on placebo were randomised 1:1:1 to amiselimod 0.1, 0.2 or 0.4 mg for another 72 weeks. Most patients receiving 0.1 mg were re-randomised to 0.2 or 0.4 mg upon availability of the core study results.


Of 415 patients randomised in the core study, 367 (88.4%) entered and 322 (77.6%) completed the extension. One or more adverse events were reported in 303 (82.6%) of 367 patients: ‘headache’, ‘lymphocyte count decreased’, ‘nasopharyngitis’ and ‘MS relapse’ were most common (14.7%–16.9%). No serious opportunistic infection, macular oedema or malignancy was reported and no bradyarrhythmia of clinical concern was observed by Holter or 12-lead electrocardiogram. The dose-dependent effect of amiselimod on clinical and magnetic resonance imaging-related outcomes from the core study was sustained in those continuing on amiselimod and similarly observed after switching to active drug.


For up to 2 years of treatment, amiselimod was well tolerated and dose-dependently effective in controlling disease activity.

The abstract, along with more information on the authors, can be seen here.
I've never heard of case managers offered to people with MS by the National MS Society, but according to this announcement I received from the NMSS by e-mail, a case manager was provided in at least one instance:

This is so astonishing that I've sent them a message inquiring about it. So far, no reply has been forthcoming but I'll post an update soon.

GENERAL DISCUSSION - RESEARCH, NEWS / (Abst.) Medication usage and falls in people w/MS
« Last post by agate on September 19, 2017, 11:33:55 am »
From PubMed, September 19, 2017:

Mult Scler. 2017 Sep 1:1352458517731912.

Medication usage and falls in people with multiple sclerosis

Comber L1, Quinn G1, McGuigan C2, Galvin R1, Coote S1.

Author information
Department of Clinical Therapies, University of Limerick, Limerick, Ireland.
St Vincent's University Hospital, Dublin, Ireland.

There is a need to identify modifiable risk factors for falls in people with multiple sclerosis (MS) to enable the design of successful falls prevention interventions.

There is conflicting evidence regarding the association between medication use and occurrence of falls in MS. A total of 101 people with MS had medications classified using the Anatomical Therapeutic Classification system and number of falls prospectively monitored for 3 months.

No association was noted between number of medications and falls. The use of genitourinary and sex hormones (odds ratio (OR) = 5.154, 95% confidence interval (CI) = 1.427-18.609, p = 0.012) and centrally acting muscle relaxant (OR = 5.181, 95% CI = 1.546-17.364, p = 0.008) medications were associated with an increased odds of being a faller.
« Last post by agate on September 18, 2017, 09:39:46 am »
If you've already received Zostavax, the shingles vaccine, should you be revaccinated with the new improved shingles vaccine that is about to become available?

This article from NEJM Journal Watch (September 18, 2017) doesn't answer this question, but it's dealing with the GlaxoSmithKline version of the new vaccine:

According to this article in FiercePharma (June 22, 2017), a rival version of the new herpes zoster (shingles) vaccine is coming from Merck, and people who have previously received Zostavax can be revaccinated with it:

"With GlaxoSmithKline eager for marketing approval,
 Shingrix passes revaccination test"

MISCELLANEOUS / Shipping containers converted into homeless housing in UK
« Last post by agate on September 17, 2017, 08:31:07 am »
Whenever I look at a list of income levels, I'm always at the very bottom of the possible incomes. It's been this way for about 37 years, ever since MS was diagnosed.

Admitting I've been at the bottom of the heap economically for the last 37 years or so is painful but it's a fact. I'm just glad I live in a country where there is a safety net for people like me.

For a couple of years there, before MS was diagnosed, I was increasingly unable to do much of anything, and I had an especially troubling worry: What if I can no longer earn a living?

I had no idea that Social Security would be there for me. I probably had a vague notion that welfare might be something I could turn to but for the most part I was in a panic about the whole question.

People who are less fortunate must live with that panic constantly, and some eventually find themselves out on the street hoping someone will drop a bit of money their way.

I sometimes feel as if I might as well be out on the street begging because I'm so dependent on services that are provided by the kindness of others in the form of the social services network.

But I'm not out there on the street. I may be waiting on hold on the phone quite often and given the brushoff or the runaround more often than not, and people in charge of pursestrings can be harsh, but I still have a roof over my head and plenty of food.

There's a new type of housing for the homeless being offered in the UK:

 It's a bit like a "tiny house."  Inside the two rooms plus bath are small and there seems to be no kitchen--maybe a microwave?

But how many people would be lucky enough to get one of those if homeless?

MS can be devastating economically.  You can get along at the very low income level in the US but it's not what most people would choose to do.
GENERAL DISCUSSION - RESEARCH, NEWS / Re: MS: Vitamin D deficiency may predict onset
« Last post by agate on September 16, 2017, 04:26:49 pm »
Abstract from Physician's First Watch, September 14, 2017:
According to this study, "Pain contributed the most to multiple sclerosis outpatients' perception of health, followed by gait dysfunction and fatigue." I found this surprising as for me, the pain I've had hasn't been directly related to the MS--though indirectly it might have been.

From PubMed, September 15, 2017:

Mult Scler J Exp Transl Clin. 2017 Sep 5;3(3):2055217317728301.

Which symptoms contribute the most to patients' perception of health in multiple sclerosis?

Green R1, Cutter G2, Friendly M, Kister I3.

Author information
Multiple Sclerosis Comprehensive Care Center, New York University Langone Medical Center, USA.
Department of Biostatistics, University of Alabama at Birmingham School of Public Health, USA.
Barnabas Multiple Sclerosis Comprehensive Care Center, RJWBarnabas Health, USA.


Multiple sclerosis is a polysymptomatic disease. Little is known about relative contributions of the different multiple sclerosis symptoms to self-perception of health.


To investigate the relationship between symptom severity in 11 domains affected by multiple sclerosis and self-rated health.


Multiple sclerosis patients in two multiple sclerosis centers assessed self-rated health with a validated instrument and symptom burden with symptoMScreen, a validated battery of Likert scales for 11 domains commonly affected by multiple sclerosis. Pearson correlations and multivariate linear regressions were used to investigate the relationship between symptoMScreen scores and self-rated health.


Among 1865 multiple sclerosis outpatients (68% women, 78% with relapsing-remitting multiple sclerosis, mean age 46.38 ± 12.47 years, disease duration 13.43 ± 10.04 years), average self-rated health score was 2.30 ('moderate to good'). Symptom burden (composite symptoMScreen score) highly correlated with self-rated health (r = 0.68, P < 0.0001) as did each of the symptoMScreen domain subscores. In regression analysis, pain (t = 7.00), ambulation (t = 6.91), and fatigue (t = 5.85) contributed the highest amount of variance in self-rated health (P < 0.001).


Pain contributed the most to multiple sclerosis outpatients' perception of health, followed by gait dysfunction and fatigue. These findings suggest that 'invisible disability' may be more important to patients' sense of wellbeing than physical disability, and challenge the notion that physical disability should be the primary outcome measure in multiple sclerosis.
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